Efficacy of high-dose therapy and hematopoietic stem cell transplantation for mantle cell lymphoma

Abstract

Conventional treatment of mantle cell lymphoma (MCL) yields modest responses and short remissions. We report 30 hematopoietic stem cell transplants (HSCT) for MCL: 13 autologous, 10 allogeneic myeloablative, and 7 nonablative. After a median 1.2 years from diagnosis (range 0.5 to 4.7) and a median of 2 pre-HSCT chemotherapeutic regimens (range 1 to 5), their median age at HSCT was 52 years (range 37 to 67). Eleven patients (41%) were in first remission, 11 (41%) were in second remission, and 7 (25%) had resistant disease. Four died early. Nineteen achieved CR (83%) and 4 PR (17%). With median 2.7 years of follow-up, 5-year overall survival (OS) was 42% (95% CI 11-73%) after autologous versus allogeneic at 49% (95% CI 22-76%). Five-year progression-free survival (PFS) was 31% (95% CI 3-59%) and 50% (95% CI 24-76%) for autologous and allogeneic HSCT, respectively. Fourteen died: 3 from sepsis, 1 acute GVHD, 10 MCL. No autologous transplant-related deaths occurred. Allogeneic transplant-related mortality was 29% (95% CI 6-52%) at 1 and 5 years.

Allogeneic hematopoietic cell transplantation in mantle cell lymphoma

“…Since all but one patient received similar myeloablative transplant conditioning regimens (cyclophosphamide plus either TBI or busulfan), the differences seen are most likely attributable to the effects and complications of an engrafted donor immune system. Similar results were seen in a smaller retrospective study from the University of Minnesota [13]. In this study, the majority of patients who received autoHCT (n = 13) were in first remission, whereas the majority of those treated with alloHCT (n = 17) had relapsed or refractory disease, including 3 patients that had relapsed following autoHCT.…”

Lifting the mantle: Unveiling new treatment approaches in relapsed or refractory mantle cell lymphoma

“…All of these small studies were characterized by selected, young patients (median age typically b 50 years), the use of a HLA-matched sibling donors, and unmodified grafts (with the exception of one study) [62][63][64][65][66][67][68][69]. These early studies demonstrated OS of 40-50% at 4 years in highly selected patient cohorts.…”

Long‐term sustained disease control in patients with mantle cell lymphoma with or without active disease after treatment with allogeneic hematopoietic cell transplantation after nonmyeloablative conditioning

“…Despite recent progress in conventional treatment, allogeneic hematopoietic cell transplantation (HCT) remains the only potentially curative treatment option for patients with mantle cell lymphoma (MCL). Initially, allogeneic HCT was attempted in these patients with high‐dose myeloablative regimens, but concerns about the relatively high risks for treatment‐related mortality have limited its use to younger, medically fit patients. Given that the median age of diagnosis with MCL is beyond the 6th decade, various groups have examined the feasibility of using reduced‐intensity or nonmyeloablative conditioning regimens for patients with MCL, and results have been encouraging .…”